체외수정과 자연임신으로 태어난 미숙아 쌍생아의 임상적 특징 비교
Comparison of Clinical Characteristics of Preterm Twins: In Vitro Fertilized versus Spontaneous Conceived
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목적: 체외수정은 불임의 흔한 치료방법으로 최근 불임률이 증가하여 체외수정에 의한 임신이 증가하면서 합병증에 대한연구가 증가하고 있다. 본 연구는 34주 미만 쌍생아를 대상으로 체외수정 군과 자연임신 군의 임상적 특징을 알아보고자 하였다. 방법: 2009년 1월부터 2011년 12월까지 부산대학교 병원과 부산대학교 어린이병원에서 출생하여 신생아 중환자실에 입원한 34주 미만 쌍생아 138명을 후향적으로 의무기록을 조사하였다. 체외수정 군 58명과 자연임신 군 80명을 대상으로 산모의 임상적 특징, 미숙아의 임상적 특징을 비교하였다. 결과: 산모의 임상적 특징에서 체외수정 군에서 산모의 나이가 유의하게 많았고(33.3±2.8 vs. 31.3±4.2, P-value=0.007), 그 외 다른 것은 의미 있는 차이가 없었다. 미숙아의 임상적 특징 중 재태주령은 체외수정 군에서 유의하게 적었으며(30.6±3.2 vs. 31.2±2.7, P-value=0.048), 완전 장관영양 도달 기간과 완전 경구영양 도달 기간은 체외 수정군에서 유의하게 길게 나와 재태주령을 교정하여 비교하였다. 완전 장관영양 도달 기간(24.2±12.1 vs. 18.2±13.2, P-value<0.001)과 완전 경구영양 도달 기간(30.1±18.5 vs. 25.3±19.2, P-value<0.001) 모두 체외수정군에서 더 길었다. 주산기 결과 중 미숙아 망막증이 체외수정 군에서 유의하게 많았으나 (P-value=0.011), 재태주령을 교정하여 비교하였더니 의미 없는 것으로 나왔다. 결론: 34주 미만 체외수정 쌍생아와 자연임신 쌍생아 간의 임상적 특징 비교에서 차이가 거의 없었으나, 재태주령을 교정한 완전 장관영양 도달 기간과 완전 경구영양 도달 기간이 체외수정 군에서 유의하게 자연임신 군보다 길게 나왔다.
Abstract
Purpose: With in vitro fertilization (IVF) becoming a common treatment for infertility, there has been an increasing number of studies on perinatal complications related to IVF. This study compares the clinical characteristics of twins at gestational age less than 34 weeks, between IVF and spontaneous conceived. Methods: We retrospectively reviewed the medical records of 138 preterm twins at gestational age less than 34 weeks, admitted between January 2009 and December 2011 to the neonatal intensive care units of two hospitals. Maternal and preterm infant’s clinical characteristics of 58 IVF and 80 spontaneous conceived twins were compared. Results: Maternal age was older in IVF twins (33.3±2.8 vs. 31.3±4.2, P-value=0.007), and there was no other significant difference between the two maternal groups. Gestational age was lesser in IVF twins (30.6±3.2 vs. 31.2±2.7, P-value=0.048). Age at the day of full enteral feeding (24.2±12.1 vs. 18.2±13.2, P-value<0.001) and age at day of full oral feeding (30.1±18.5 vs. 25.3±19.2, P-value<0.001) were significantly longer in IVF twins as adjusted by gestational age. Retinopathy of prematurity (ROP) showed higher incidence in IVF twins (P-value=0.011), but there was no significant difference between the two groups after adjusting gestational age. Conclusion: The clinical characteristics in IVF twins at gestational age less than 34 weeks were not significantly different from those of spontaneously conceived twins except age at the day of full enteral feeding and age at the day of full oral feeding after adjusting by gestational age.
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